POS1498-HPR NEWLY DIAGNOSED WITH INFLAMMATORY ARTHRITIS – DEVELOPMENT OF A COMPLEX SELF-MANAGEMENT INTERVENTION
Authors: L. Lindgren, T. Thomsen, M. Aadahl, A. De Thurah, M. L. Hetland, S. Kristensen, B. A. Esbensen
Journal: Annals of the Rheumatic Diseases (2022)

Background People newly diagnosed with inflammatory arthritis (IA) request regular consultations and support from health professionals (HPRs) in rheumatology to manage physiological, emotional, and social challenges. Evidence suggests that providing a tailored tailormade multi-component self-management program may benefit disease management (1). However, there is a lack of evidence in interventions with multiple components targeting people newly diagnosed with IA. Objectives To develop a complex evidence- and theory-based intervention in co-creation with patients and HPRs for better self-management in newly diagnosed people with IA in a rheumatology out-patient clinic. Methods This study followed the Medical Research Council (MRC) Framework (2,3) for developing a complex intervention. The development phase comprised 1) identifying the evidence base, 2) identifying theory, 3) modelling process and outcomes, resulting in 4) a final description of all components and outcomes of the intervention. 1) Identifying the evidence base We conducted two literature reviews, on which, we described a preliminary nurse-led intervention. 2) Identifying theory Given the fact that the theory of Self-management is built upon Social Cognitive Theory (4) this was chosen as the underlying theory along with Acceptance and Commitment Theory (5) to support our communication strategy. 3) Modelling process and outcomes The preliminary intervention was discussed and further developed in seven workshops to ensure that the intervention was in accordance with patients’ needs and feasible in clinical practice. Three patients and 38 HPRs (nine therapists, 10 rheumatologists, one psychologist, one social worker, and 17 registered nurses) attended. During the workshops we identified the competencies needed in the HPRs delivering the intervention. In addition, relevant outcomes to measure self-management in a subsequent feasibility study were discussed. Discussions were digitally recorded and analysed using Thematic Analysis (6). Subsequently, the project group discussed the analysis and consensus was reached. Results 4) Description of all components and outcomes of the intervention Our intervention, ready for testing in a feasibility study, was a 9-month nurse-led intervention, and consisted of four individual and two group sessions. A physiotherapist and an occupational therapist should attend the group sessions along with the nurse (Figure 1). All sessions should target inflammatory arthritis-specific self-management. Figure 1. Intervention activities and A comprehensive intervention manual has been developed. Our patient research partner and experts in rheumatology and self-management commented on the content to secure content validity. Subsequently, we conducted cognitive interviews with the HPRs to determine the face validity of the manual. In addition, we completed a two-day competence program to train HPRs in delivering the intervention. The selected patient reported outcomes were: Physical activity levels, Health assessment, Fatigue, Quality of life, Anxiety and depression, Illness intrusiveness, Illness perception, and Self-efficacy, supplemented with objective measures for diseases activity. Conclusion NISMA - a nurse-led complex self-management intervention embedded in a multidisciplinary team has been developed and described based on MRC’s framework for the development of complex interventions. The intervention is currently being tested in a feasibility study. References [1]Nikiphorou et al., Annals of the Rheumatic Diseases. 1. oct 2021. [2]Skivington et al., BMJ. 30. sep. 2021. [3]Craig et al., nt J Nurs Stud. may 2013. [4]Bandura A. SOCIAL COGNITIVE THEORY. [5]Newman et al., Lancet. oct 2004. [6]Braun et al., Springer; 2019. Acknowledgements First, I would like to thank the patients and health professionals who attended the workshops. Secondly, I would like to thank The Novo Nordic Foundation for funding. Disclosure of Interests None declared